Róisín Shortall (Dublin North West, Social Democrats) | Oireachtas source

I very much welcome the opportunity to speak in this debate and welcome the tabling of this motion by Deputy Butler. It is very important that we take time in this House to talk about what is a very pressing issue, namely, the services or, in many cases, the lack of services for older people, particularly with regard to health and social care. Healthcare for older people is sometimes regarded as a minority aspect of the health service or an add-on when the provision of services for older people is integral to how we organise our health service and ensure that people are provided with an opportunity to live as long as possible, to live a life free from disability or chronic illness and to live with dignity. This should be everybody's entitlement but, unfortunately, it is not. If we are to uphold those rights, it is incumbent on Government to ensure that adequate services are available. Unfortunately, this has not been the case to date. Not only should older people be entitled to appropriate services provided at the appropriate time in the appropriate location, it makes significant sense for the health service generally to provide those services in an appropriate way.

This is how we ensure we have the most efficient health services available and at the same time get much better value for money. Delayed discharges are an issue across the country. Many people in acute hospital beds whose acute phase of treatment is complete and who are ready to go home with supports or move to a step-down facility or nursing home are awaiting physiotherapy. At any one time over recent years there have been between 500 and 600 people in acute hospital beds who are ready to leave hospital but cannot be discharged because funding is not being provided for home care supports or step-down facilities. In terms of health service management, this is a no-brainer yet the issue has not been addressed head on. This is, in part, due to the manner in which the HSE operates and the way in which it has been structured by Government. On the one hand, we have hospitals and on the other hand we have community social care services and never the twain shall meet. They do not speak to each other and they operate under separate budgets, which is one of the reasons our health services are dysfunctional and we get poor value for money.

Today, it was announced that funding is to be provided for an additional 550 home care packages, which is good news but it should have happened long before now. We should not have spent the last few years with hospital beds being occupied by people who are ready to go home and all of the knock-on implications of that for older people and the operation of the hospitals. This is not a once-off need. The funding is welcome but this is a constant issue. For as long as we have a dearth of supported places in the home for older people and a shortage of step-down facilities and nursing home places, we will continue to have large numbers of acute hospital beds occupied by people who are ready to be discharged. This makes no sense. In terms of the operation of the hospitals, when this is the case, we do not achieve the level of value of money one would expect from the use of those hospital beds to accommodate patients who come through the emergency departments or from the waiting list for elective surgery because those beds are effectively closed from the point of view of other patients. They are inappropriately occupied, which means there are major inefficiencies within the hospitals. It means that the normal throughput of patients, for example, admitting people for hip operations and moving them to hospital wards three or four days later to enable recovery, cannot happen and this is leading to further increases in the waiting lists. It also leads to a shortage of beds for admissions through emergency departments, which causes blockages in emergency departments and extra beds being placed in wards and so on. As a result of there being between 500 and 600 delayed discharges at any one time, these beds are lost to the system, with the resultant loss of value for money and inefficiencies on the part of staff and hospital management. As I said, the announcement is welcome but we should ensure that delayed discharges are kept to a minimum on an ongoing basis.

We do not have an entitlement to home care on a statutory basis. This is long overdue and I welcome that work is being done in this area, albeit painfully slowly. It makes no sense from the point of view of the patient or from a health management point of view to have a system which provides for a statutory entitlement to a nursing home place at a cost of €1,300 or more per week and no similar statutory entitlement to a home care package which costs a fraction of the cost of a nursing home place. The cost of an acute hospital bed is €1,200 per night. The cost of a nursing home place is €1,200 per week and a decent home care package costs less than €200 per week. It is a no-brainer. I do not know why we are being so inefficient and disrespectful of the wishes and best interests of older people who find themselves in this position.

It is welcome that funding is being provided for delayed discharges and additional home care packages. However, there are many older people in their 70s, 80s or 90s who are living at home and are infirm and becoming less mobile, very often with nobody to look after them, who have never been in the hospital system and are not in the hospital delayed discharges category but are waiting on home care packages. Currently, there are 6,287 people on waiting lists for home care packages. This is an indictment of Government policy. As public representatives, we deal daily with people whose sight or mobility is severely impaired and who are at high risk of falling. Despite having been assessed and deemed to be in urgent need of a home care package, they are place on a waiting list. As I said, there are currently over 6,000 people in this category. The longer they remain without support in their homes, the more likely they are to fall or burn themselves and end up in emergency departments. This is one of the drivers of the high number of presentations at emergency departments, particularly in winter. Again, this issue could be addressed by joined up thinking in this area. We must ensure that there are services available to support people to remain in their homes, where they have the best health outcomes and we achieve the best value for money.

What is happening in regard to home help services and home care organisations is a disgrace. There is now a race to the bottom, with community organisations that have been providing these services for years on end being sidelined in the name of privatisation. Services are being contracted out in many cases to companies whose main interest is the profit to be made. Meanwhile, many people who have provided excellent services to the State are being swept aside. We will pay a huge price for this because standards and terms of employment are dropping and, most important, the quality of service being provided to older people is disimproving as a result of this trend. This has happened in my constituency in regard to the Drumcondra Home Help and Care Services Company, with which I have engaged recently on this issue. The HSE is being forced to consider only the bottom line rather than quality of service. This is a disgraceful move in regard to home help services and home care services. As I said, we will pay a huge price for this but, most important, older paying are currently paying the price for it.

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